September

Increasing mortality gap for mental health sufferers must be addressed

Despite improvements in mental health care, people with schizophrenia or bipolar disorder still face a “persistent and increasing” risk of mortality compared with the general population, concludes a study published in the British Medical Journal. Whilst the UK government has already recognised and prioritised the importance of preventing premature mortality in its recently published mental health strategy, the authors, from the Institute of Psychiatry (IoP) King’s College London and the University of Oxford call for continued action to target risk.

Researchers analysed records for all people in England discharged from inpatient care with a diagnosis of schizophrenia or bipolar disorder and compared their mortality with the general population from 1999 to 2006. Recent evidence suggests that the rate of suicide has been stabilising among people with mental illness in the UK, and the findings revealed that three quarters of deaths were the result of natural causes, primarily circulatory and respiratory diseases.

The study also revealed a significant increase over time in the mortality gap between patients with schizophrenia or bipolar disorder, and the general population. Mortality rates in those under 65 with schizophrenia or bipolar disorder were stable, meaning they had not benefitted from the decline in mortality experienced in the general population within this age group. However, mortality rates in those over 65 with these conditions had actually increased.

Dr Robert Stewart, lead investigator of the study at the IoP says: ‘We’ve known from previous research here at the IoP that people with schizophrenia and bipolar disorder have life expectancies that are often 10-20 years lower than those of the general population.

‘This particular study highlights that these inequalities are persistent in the UK and even widening in some groups. What’s worrying is that even though numerous policy statements acknowledge the higher mortality rate of people with mental disorders, there has been little of no improvement of the situation to date. This presents a key challenge not only for mental health services but more widely across the whole of the NHS.’

Prof Philip McGuire, Head of the Department of Psychosis Studies and Academic Lead of the Psychosis Clinical Academic Group at the IoP, says: ‘This paper adds to the increasing evidence that patients with psychotic disorders have a significantly reduced life expectancy, and that this is largely due to relatively high rates of concurrent physical illness.

‘Addressing this issue is a key priority for the Psychosis Clinical Academic Group, which is conducting a programme of studies designed to clarify why physical illness is more common among our patients, and to improve the recognition and treatment of these problems. Within King’s Health Partners, the close integration between the Psychosis Clinical Academic Group and colleagues with expertise in physical health greatly facilitates this work.’

The study was led by Dr Uy Hoang, an academic clinical fellow from the University of Oxford and lead author of the study currently completing a degree of Doctor of Medicine Research at the IoP. The study received support from the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at the Institute of Psychiatry, King’s College London and the South London and Maudsley (SLaM) NHS Foundation Trust.

Dr Fiona Gaughran and Dr Shubulade Smith from the Institute of Psychiatry and the South London and Maudsley NHS Foundation Trust spoke to Harriet Vickers from the BMJ about possible ways to tackle the issues raised in this paper. To listen to the podcast, please click here.